Search Results (582)

Obstructive sleep apnea syndrome (OSAS) is heavily implicated in subclinical cardiovascular disease; however, traditional polysomnographic metrics fail to capture the localized mechanical trauma exerted on the carotid artery. To address this methodological gap, this study evaluated exploratory associations between frequency-domain snoring characteristics and right carotid artery alterations in 50 patients with OSAS. Snoring was quantified using a dual-modality bioelectronic approach: an ambient microphone captured airborne snoring sound energy (SSE), while a portable neck-surface piezoelectric sensor recorded tissue-conducted snoring vibratory energy (SVE). Subclinical vascular changes, including carotid intima-media thickness (CIMT) and atherosclerosis, were assessed via ultrasonography. Hierarchical multivariable regression demonstrated that acoustic SSE%-404–500 Hz and mechanical SVE%-112–144 Hz independently correlated with preliminary CIMT increases (adjusted β = 0.033 and 0.021, respectively; both p < 0.05), alongside neck circumference. Conversely, SSE%-404–500 Hz emerged as an exploratory marker for focal carotid atherosclerosis (adjusted odds ratio = 1.828; p = 0.009). Integrating this metric with baseline parameters yielded exploratory diagnostic capacity (area under the curve = 0.833; p < 0.001), achieving 89% sensitivity and 69% specificity. These findings suggest that dual-modality spectral analysis provides a non-invasive exploratory framework for cardiovascular risk stratification, isolating localized mechanotransduction phenotypes independently of systemic hypoxia. Full article

Pediatric obstructive sleep apnea (OSA) is a common disorder associated with significant neurocognitive, behavioral, cardiovascular, and metabolic consequences. Although adenotonsillectomy remains first-line therapy for many children, residual OSA is common, particularly among those with obesity, craniofacial abnormalities, genetic syndromes, neuromuscular disease, or other forms of medical complexity. Continuous positive airway pressure (CPAP) is the standard non-surgical treatment; however, long-term effectiveness is frequently limited by poor tolerance and adherence. Heated high-flow nasal cannula (HFNC) therapy has emerged as a potential alternative for selected children with sleep-disordered breathing, particularly those who are unable to tolerate conventional positive airway pressure therapy. Unlike CPAP, HFNC delivers heated, humidified gas through an open nasal interface and may improve sleep-disordered breathing through a combination of flow-dependent positive airway pressure generation, dead-space washout, improved ventilatory efficiency, enhanced gas conditioning, and reductions in inspiratory resistance. However, the relative contribution of these mechanisms during sleep remains incompletely understood. Current clinical evidence consists primarily of physiological studies, retrospective cohorts, case series, and a limited number of prospective comparative studies. Collectively, these data suggest that HFNC can reduce obstructive respiratory events and improve oxygenation in selected pediatric populations, including children with persistent OSA, CPAP intolerance, medical complexity, and syndromic conditions. Nevertheless, important uncertainties remain regarding optimal patient selection, titration strategies, patient monitoring, long-term adherence and comparative effectiveness relative to CPAP. This review summarizes the physiological basis of HFNC therapy, critically appraises the current clinical evidence, discusses practical considerations related to adherence and implementation, and highlights key knowledge gaps and future research priorities. Overall, HFNC should be viewed as an alternative for selected children who cannot tolerate CPAP, rather than as a universal substitute for pressure-based therapy. Full article

Obstructive sleep apnea (OSA) syndrome is characterized by repetitive nocturnal airway obstruction and is associated with intermittent hypoxia (IH). The leading cause of death among OSA patients is cardiovascular morbidity, which is greatly enhanced by IH. Despite the existence of standard treatment, cardiovascular morbidity remains unaddressed. Given the central role of IH in OSA-related cardiac damage, the present study aimed to elucidate the mechanisms underlying IH-induced cardiac injury in order to better understand and potentially improve upon current therapeutic approaches. Using human embryonic stem cell-derived cardiomyocytes (hESC-CMs) as a novel in vitro model, IH was successfully induced, and its effects on key signaling pathways were investigated. Following IH exposure, significant activation of ERK1/2, ERK5, and Erbin was demonstrated. Notably, the concurrent increase in both ERK1/2 activation and Erbin expression following IH suggests a more complex regulatory relationship between these molecules than previously appreciated. Furthermore, pathway-specific inhibition of ERK1/2 and ERK5 attenuated the IH-induced decline in beating rate, with significant restoration, following normoxic recovery. This study provides an innovative approach for in vitro investigation of OSA-associated cardiovascular morbidity and supports the search for novel pharmacological agents and molecular targets to improve the diagnosis and treatment of affected patients. Full article

Background: Obesity hypoventilation syndrome (OHS) is a life-threatening condition often underdiagnosed in patients with obstructive sleep apnea (OSA). While bariatric surgery induces weight loss, it does not immediately resolve upper airway obstruction. We investigated the feasibility and clinical predictors of a novel transdisciplinary approach—Combined Airway and Bariatric Surgery (CABS)—in treating OHS. Methods: This prospective observational cohort study (December 2022–November 2024) recruited 36 adults with obesity (body mass index [BMI] ≥ 30 kg/m²) and OSA (apnea–hypopnea index [AHI] ≥ 5 events/h). OHS was diagnosed by daytime hypercapnia (PaCO₂ ≥ 45 mmHg) after excluding other causes of hypoventilation. Participants received CABS or positive airway pressure therapy via shared decision-making. Primary outcomes included changes in AHI, BMI, PaCO₂, and Epworth Sleepiness Scale (ESS). Results: Nine of 36 individuals (25%) had OHS. Multivariate logistic regression identified BMI and ESS as significant predictors. Receiver operating characteristic curve analysis showed high OHS prediction with BMI ≥ 35.5 kg/m² (area under the curve [AUC] = 0.85), ESS ≥ 12 (AUC = 0.72), and a novel OHS prediction score > 20 (AUC = 0.94). Among 6 OHS patients who underwent CABS, one-year follow-up showed significant improvements: AHI decreased from 98.1 to 26.8 events/h, BMI from 40.1 to 29.1 kg/m², and PaCO₂ from 50.2 to 37.9 mmHg (all p < 0.05). Conclusions: OHS was present in one-quarter of individuals with obesity and OSA in this cohort. CABS was feasible and associated with encouraging improvements in sleep-disordered breathing, ventilatory status, and weight among selected patients. These preliminary findings support further evaluation of this transdisciplinary strategy in larger, comparative studies. Full article

Goldenhar syndrome is a developmental defect of the 1st and 2nd brachial arches. Facial asymmetry and ear–eye abnormalities are observed. Frequent presence of concomitant issues, including severe OSA (obstructive sleep apnea) and sialorrhea, have also been recorded. The presentation of Goldenhar syndrome is highly variable, and treatment procedures also differ, with surgical treatment often being mandatory. Common symptoms of OSA include loud snoring, gasping, and morning headaches. If untreated, it may lead to high blood pressure, hyperinsulinemia, heart problems, stroke, and daytime sleepiness. Its etiology in Goldenhar syndrome is primarily anatomical and multifactorial. The most common treatment options are based on surgical procedures. Continuous positive airway pressure (CPAP) could be considered for use in individuals with Goldenhar syndrome. Mandibular advancement is a standard procedure for relieving the symptoms of OSA. In general, mandibular advancement would reduce apnea and hypopnea. Another method of managing OSA is hypoglossal nerve stimulation (HNS). Adenotonsillectomy is often the first-line surgical treatment for OSA but it is rarely curative in Goldenhar patients due to underlying skeletal issues. In contrast to American Academy of Sleep Science recommendations of managing OSA, in patients with congenital syndromes, surgical intervention seems to be the most optimal method of treatment. Full article

The carotid body (CB) is an interoceptive organ that transmits afferent information to the brain via the carotid sinus nerve (CSN) to maintain homeostasis, i.e., the regulation of internal equilibrium despite external changes. It functions as a complex polymodal receptor capable of sensing multiple stimuli, including blood flow, osmolarity, pO₂, pH, pCO₂, CO₂/H⁺, and temperature. In addition, the CB responds to a wide range of circulating molecules such as angiotensin II, endothelin-1, aldosterone, insulin, histamine, and leptin, and expresses receptors for interleukins (ILs) and tumor necrosis factor-α (TNF-α) (1). CB dysfunction has been associated with conditions such as obstructive sleep apnea (OSA), in which intermittent hypoxemia induces an inflammatory response mediated, among other mechanisms, by reactive oxygen species (ROS). This process contributes to alterations in respiratory drive and enhanced sympathetic nervous system activity. Following streptococcal toxic shock syndrome due to Streptococcus Pyogenes, severe abdominal septic shock, and multiple infectious complications, our patient developed an altered respiratory pattern and a hypercatabolic state that precluded weaning from mechanical ventilation (MV) despite respiratory physiotherapy. Given treatment failure, we hypothesized underlying carotid body (CB) hyperexcitability, likely pre-existing due to obstructive sleep apnea (OSA) and exacerbated by cytokine storm and severe systemic inflammation related to Strept. Pyogenes toxins and subsequent abdominal sepsis from colonic perforation. This may have contributed to sustained sympathetic overactivation and immune dysregulation. Clinically, the patient exhibited increased respiratory drive (30–35 breaths/min), excessive inspiratory effort, and marked patient–ventilator asynchrony in the absence of hypoxemia. Non-targeted physiotherapy may have acted as a second inflammatory hit, perpetuating the inflammatory cycle. Full article

Background: Systematic among patients with bilateral vocal fold paralysis (BVFP), the most clinically significant symptom is dyspnea, which often requires surgical intervention. One of the most common causes of BVFP is iatrogenic injury during thyroidectomy. Some patients report not only day time breathing difficulties but also a deterioration in sleep quality since the onset of BVFP. Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder caused by recurrent upper airway obstruction during sleep. Although it is usually associated with pharyngeal collapse, fixed laryngeal obstruction has also been suggested as a potential contributor to sleep-disordered breathing. Therefore, we aimed to assess the impact of surgical treatment of OSA in patients with BVFP. Methods: Between 2022 and 2025, 18 patients with BVFP were screened. Patients who met diagnostic criteria for OSA based on preoperative polysomnography (PSG) and the Epworth Sleepiness Scale (ESS) AHI ≥ 15 events/h or AHI ≥ 5 events/h with associated symptoms were included in the study. Five female patients met the criteria and underwent arytenoidectomy combined with posterior cordectomy. A follow-up PSG and re-evaluation of ESS were performed 6–12 months after surgery, and patients were asked about their subjective perception of sleep quality improvement. Results: An improvement in sleep quality, decrease in the median ESS score and respiratory parameters showed an improvement, although this was not statistically significant due to the small sample size (n = 5). Conclusions: These results indicate a positive postoperative trend in sleep quality among patients with BVFP however, given the limited sample size, further studies are required to confirm these observations. Full article

Background/Objectives: Obstructive sleep apnea (OSA) is highly prevalent in children with unilateral cleft lip and palate (UCLP) due to maxillary retrusion and upper airway compromise. While palatal morphology may influence pediatric OSA, three-dimensional (3D) evaluations in this population remain limited. This study evaluated palatal dimensions and maxillary widths in UCLP children with and without OSA using cone-beam computed tomography (CBCT) and examined their associations with OSA severity (apnea–hypopnea index, AHI). Methods: Forty CBCT scans of Thai children with non-syndromic UCLP (mean age 8.98 ± 1.99 years) were analyzed. Participants were categorized into OSA (n = 20; AHI ≥ 1) and non-OSA (n = 20; AHI < 1) groups. Reconstructed palatal structures were measured for surface area, volume, height, and transverse maxillary widths. Group differences were assessed using independent t-tests, and associations with AHI were examined via Pearson’s correlation and linear regression (p < 0.05). Results: Children with OSA exhibited significantly reduced palatal surface area, volume, height, and buccal alveolar crest width compared with those without OSA (p < 0.05). Other transverse widths showed no significant intergroup differences. Linear regression identified palatal volume as the only variable independently associated with AHI (β = −0.631, p < 0.001). Conclusions: Children with UCLP and OSA exhibit significantly constricted palatal morphology. Among the measured parameters, reduced three-dimensional palatal volume was the only variable independently associated with increased OSA severity in this sample. Thus, CBCT-based palatal volume assessment may serve as a preliminary screening parameter to help identify OSA risk within multidisciplinary cleft care, though further validation is needed. Full article

Background: Gorlin–Goltz syndrome is a rare autosomal dominant condition with characteristic craniofacial and odontogenic anomalies. Orofacial alterations in childhood may precede dermatological findings, highlighting the relevance of early orthodontic and functional evaluation. Objective: This case describes a multidisciplinary orthodontic and Home Sleep Apnea Testing (HSAT)-based approach for the assessment of craniofacial morphology and sleep-disordered breathing (SDB) risk in a pediatric patient with Gorlin–Goltz syndrome. Methods: A 12-year-old male with a genetically confirmed PTCH1 mutation underwent digital intraoral scanning, orthodontic evaluation, and SDB screening using the Pediatric Sleep Questionnaire (PSQ). Following a positive screening score, HSAT with the Philips Alice NightOne^® system was performed under specialist supervision. Results: The patient showed recurrent odontogenic cysts, a lateral open bite, and unilateral Class II canine relationship. The PSQ score was 0.579, exceeding the validated cut-off of 0.33 and indicating an elevated SDB risk. HSAT findings were suggestive of mild obstructive sleep apnea based on Respiratory Event Index (REI) values (REI 4.7/h), with an isolated SpO₂ nadir of 77% and a maximum recorded apnea duration of 425 s, warranting cautious specialist interpretation and follow-up assessment. Conclusions: Integrating orthodontic assessment, digital documentation, validated screening tools, and objective HSAT-based evaluation may support the early recognition of functional compromise in syndromic pediatric patients. Positive screening results should prompt specialist referral and objective sleep assessment, while attended polysomnography remains indicated when comprehensive sleep architecture evaluation or definitive characterization is required. Full article

Background and Objectives: It is well established that obstructive sleep apnea syndrome (OSAS) is associated with functional lung volumes. The aim of this study was to investigate the relationship between morphological lung volume and the severity of OSAS. Materials and Methods: Adult patients evaluated for sleep disorders between January 2020 and January 2024 were retrospectively reviewed. Patients with an AHI greater than 5, who underwent both spirometry and thoracic CT within a three-month interval, were included. Spirometric functional volume and morphological CT lung volume were assessed. Associations between OSAS severity and both functional and morphological lung volumes were analyzed. Results: A total of 195 patients were enrolled, of whom 166 had CT scans suitable for lung volume assessment. Among all patients, 20 (10.3%) were in the mild, 39 (20.0%) in the moderate, and 136 (69.7%) in the severe OSAS group. Ordinal regression analysis was performed to evaluate the factors influencing these categories. Age (p < 0.001) and BMI (p < 0.001) were positively correlated with disease severity, whereas female sex was associated with a lower risk of severe disease (p = 0.003). Conclusions: Functional and morphological lung volumes did not affect OSAS severity. Functional and morphological lung volumes were positively correlated with each other. Both morphological and functional lung volumes showed negative correlations with BMI. Full article

Background: Obstructive sleep apnea syndrome (OSAS) is a prevalent sleep-related breathing disorder associated with significant systemic complications and reduced quality of life. Mandibular advancement devices (MADs) represent an established alternative therapy for patients who cannot tolerate continuous positive airway pressure (CPAP). However, concerns remain regarding their potential effects on temporomandibular disorders (TMD). Materials and Methods: This retrospective exploratory study analyzed clinical records of 26 patients (mean age 55.4 ± 5.8 years) with polysomnography-confirmed OSAS and baseline TMD-related symptoms treated with a custom-made monobloc MAD. Clinical parameters were evaluated at baseline (T0) and after approximately 6 months of therapy (T1). Outcomes included apnea–hypopnea index (AHI), Epworth Sleepiness Scale (ESS), Fonseca Anamnestic Index, and health-related quality of life assessed using the SF-36 questionnaire. Repeated measures ANOVA and linear regression analyses were performed. Results: After six months of MAD therapy, a significant reduction in AHI was observed (30 ± 13.76 vs. 10.87 ± 3.9; p < 0.00001). Daytime sleepiness significantly decreased (ESS: 9.31 ± 3.53 vs. 3.38 ± 1.77; p < 0.00001). TMD symptom severity also decreased significantly according to the Fonseca Index (33.85 ± 17.74 vs. 10.00 ± 8.94; p < 0.00001). Quality of life scores improved significantly (SF-36: 41.15 ± 9.52 vs. 65.38 ± 5.82; p < 0.00001). Linear regression analysis showed no significant association between changes in AHI and changes in TMD symptoms, ESS scores, or quality of life. Conclusions: Within the limitations of this retrospective study, MAD therapy was not associated with symptom aggravation of temporomandibular disorders in patients with pre-existing TMD symptoms. Significant improvements in respiratory parameters, daytime sleepiness, and quality of life were observed after six months of therapy. Full article

Background: Continuous Positive Airway Pressure (CPAP) therapy is the standard treatment for obstructive sleep apnea–hypopnea syndrome (OSAHS), and photoplethysmography (PPG) sensors are commonly used in wearable devices for home sleep apnea testing. The recorded airflow and PPG signals from both sensors capture rich physiological patterns. We hypothesize that by combining information from these signals, we can efficiently estimate sleep dynamics of patients receiving CPAP treatment. Methods: The airflow signals were obtained from CPAP titration devices, denoted as CPAP-airflow, while the PPG signals were collected using the PranaQ TipTraQ (TTQ001), a fingertip-worn wearable device. We separately trained one-dimensional convolutional neural networks for CPAP-airflow and PPG signals and fused their outputs through probabilistic ensembling to predict sleep stages. The ensemble method is a late-fusion soft-voting scheme that computes a linearly weighted combination of synchronized softmax probability vectors from the modality-specific models. Results: For three-stage classification (Wake, REM, NREM), the PPG-based and CPAP-airflow-based models achieved overall Cohen’s kappa scores of 0.511 and 0.452, respectively, while the ensembled model improved the overall kappa to 0.587. The F1-score for the REM stage improved to 0.706 using the ensemble method, compared to 0.685 and 0.532 achieved by the individual models, respectively. In the four-stage classification (Wake, REM, Light, Deep) task, a deep sleep sensitivity of 0.596 was attained through the application of probabilistic ensembling. Conclusions: A fusion scheme of complementary information from the CPAP and PPG enhances the accuracy of sleep stage detection and hence enables more precise sleep monitoring, especially with an improved REM identification. Clinical implications include applying the proposed algorithm to improve in-home auto-CPAP titration by capturing REM-related respiratory instability and avoiding under-titration in REM-dominant OSAHS, better reflecting the patient’s true nocturnal respiratory needs. Full article

Background/Objectives: Cephalometric analysis is essential in orthodontics and for studying conditions such as obstructive sleep apnea syndrome (OSAS). However, manually identifying anatomical landmarks and segmenting the pharyngeal airway on lateral cephalograms can be time-consuming and prone to errors. This study evaluates the CEPH_2D system, an AI-based tool designed to automate cephalometric landmark detection and pharyngeal airway segmentation from 2D lateral cephalometric radiographs. Methods: The system was evaluated on 35 anonymized lateral cephalograms obtained from patients aged 6–65 years, including mixed and permanent dentition cases. Two experienced clinicians generated and reviewed the ground truth annotations for cephalometric landmark localization and pharyngeal airway segmentation. System performance was assessed using mean radial error (MRE), successful detection rate (SDR), mean average precision (mAP), Dice similarity coefficient (DSC), precision, recall, and inference time. Results were compared with manual methods and existing automated tools. Results: The system reached a mean radial error (MRE) of 0.740 ± 0.793 mm for the key point detection task and a mean Dice Score (mDSC) of 0.935 ± 0.040 with an average processing time of 2.557 ± 0.504 s. Conclusions: CEPH_2D appears to be a promising adjunctive tool for automatic cephalometric landmark detection and pharyngeal airway segmentation on lateral cephalograms, although clinician verification remains advisable before clinical interpretation or treatment planning, particularly for landmarks showing higher detection errors. Full article

Background: This study aimed to evaluate the effects of obstructive sleep apnea syndrome (OSAS) surgery on oxidative stress, antioxidant capacity, and oxidative protein modifications. Changes in Total Oxidant Status (TOS), Total Antioxidant Status (TAS), Advanced Oxidation Protein Products (AOPP), Ischemia-Modified Albumin (IMA), and Total Thiol (TT) levels were analyzed in the preoperative and postoperative periods. Methods: Sixty-seven patients aged 18–65 years with an Apnea–Hypopnea Index (AHI) > 5 who underwent OSAS surgery were included. Demographic characteristics were recorded. Venous blood samples were collected at four time points: before anesthesia induction (T1), at the end of surgery (T2), on postoperative day 3 (T3), and at postoperative month 3 (T4). TOS, TAS, AOPP, IMA, and TT levels were measured and statistically evaluated. Results: Of the patients, 13.4% (n = 9) were female and 86.6% (n = 58) were male. No significant changes were observed in TOS, TAS, AOPP, or IMA levels between time points. However, TT levels at postoperative month 3 were significantly higher than those at earlier measurements (p < 0.05). Positive correlations were found between AHI and TOS, AOPP, and IMA levels, while TAS and TT showed no significant correlation with AHI. Conclusions: Surgery for OSAS did not produce significant postoperative improvements in oxidative stress parameters except for TT elevation. These results indicate that surgical intervention alone may be insufficient for biochemical recovery in OSAS and should be complemented by lifestyle and supportive therapies. Full article

Introduction: Obstructive sleep apnea (OSA) is highly prevalent, affecting up to 50% of individuals over 65 years. Elderly patients often present with atypical, fewer and less severe symptoms, suggesting age-specific phenotypes. However, comprehensive clinical phenotyping that incorporates cognitive outcomes remains limited. This study aimed to characterize OSA phenotypes through cluster analysis and evaluate their association with cognitive impairment, independently of age. Materials and Methods: Between 2020 and 2024, 409 adults with moderate-to-severe OSA were enrolled and stratified into three age groups (<65, 65–74, ≥75 years). All underwent home sleep apnea testing (HSAT), comprehensive symptom assessment, Epworth Sleepiness Scale (ESS), and Montreal Cognitive Assessment (MoCA, pathological ≤ 25 pts). Hierarchical cluster analysis (Ward’s method) used AHI, T90, BMI, and ESS. Logistic regression identified independent predictors of cognitive impairment. Results: Older groups showed lower BMI, higher comorbidity burden, fewer symptoms, and greater cognitive impairment prevalence (4.5% vs. 9.7% vs. 45.9%; p < 0.001), despite comparable polysomnographic severity across age groups. Cluster analysis identified three phenotypes: Cluster 1 (classical OSA: high AHI, BMI, T90, ESS); Cluster 2 (geriatric phenotype: low AHI, BMI, T90, ESS, highest cognitive impairment rate: 27.7%); Cluster 3 (hypersymptomatic: low AHI and T90, high sleepiness and asthenia, prevalent depression). On multivariate regression, age (OR 1.155; p < 0.001), male sex (OR 2.223; p = 0.034), and Cluster 2 (OR 3.131; p < 0.001) were independent predictors of cognitive impairment. Conclusions: Three clinically distinct OSA phenotypes were identified regardless of age and severity. The geriatric phenotype was associated with three-fold increased risk of cognitive impairment, supporting routine cognitive screening and age-adapted diagnostic strategies in elderly OSA patients. Full article